How to get to the diagnosis of nail mycosis

Often, but not always, it is enough to see the stains to understand what it is.

Often it is enough to see the stains to understand what it is. But to be sure it is better to analyze the fungi under a microscope.

Nail edges inflamed, with small cuts, raised skins and fragments of lighter epidermis on the verge of detaching. Lamina of the nail dull, with whitish or yellow-brown spots, which tends to deform and crumble. Burning or pain more or less accentuated.

If you recognize these signs at the level of one or more fingers or toes (in particular, the thumb and big toe), it is advisable to consult your doctor to understand what the origin of the problem is.

It could be a passing inflammation, perhaps due to a small accidental trauma that has not even been noticed, or an onychomycosis, to be treated immediately and specifically to prevent it from further damaging the nail, up to risk its loss.

What to tell the doctor

Already at first glance the family doctor, and even more easily the dermatologist or podiatrist, will be able to hypothesize whether a pathogenic microorganism may have determined or aggravated the disorder.

This initial suspicion can be better oriented by informing the doctor about their hygiene and life habits, the professional activity and hobbies to which they dedicate themselves in their free time, the presence of any chronic diseases (in particular, diabetes, alteration of the immune defenses, psoriasis) and the intake of pharmacological therapies that can favor the onset of a nail mycosis (corticosteroidsantibiotics, immunosuppressive drugs, etc.).

Although not specifically requested, to facilitate the diagnosis of onychomycosis of the feet you should report to your doctor if you exercise regularly and what type (gym, running, swimming pool, etc.), what kind of shoes and socks you usually use, how often and how you wash and dry your feet, if you have the habit of walking barefoot or wearing slippers or other people’s shoes (for example, of siblings or friends, etc.) And, above all, if you have already had mycosis of the foot in the past, even if they have not affected the nails (for example, tinea pedis).

In the case of hands, however, it should be indicated if you wet them very often during the day, if you use protective gloves during household chores or at work, if you regularly attend manicure centers or if you have the habit of nibbling the foil and / or the edges of the nails.

To understand if it is really a mycosis

At this point, much of the work is done. To issue a specific differential diagnosis, i.e. to understand which pathogenic microorganism has actually caused nail mycosis, and plan the most appropriate therapy, all that remains is to take a small sample of the affected nail (and possibly of the surrounding cuticles) and proceed to some laboratory analysis.

The nail fragments to be examined are removed painlessly (or with minimal discomfort) thanks to a normal nail cutters or gently scraped with a small cutter, a gouge or the blade of a scalpel used transversely, after disinfecting the sampling area.

A part of the sample thus obtained is then subjected to a specific staining that makes it better observable under a microscope. In this way, often, it is possible to understand within about an hour if to cause onychomycosis was a dermatophyte fungus (in most cases Trichophyton rubrum) or a yeast (almost always, of the genus Candida).

In search of the responsible microorganism

To have absolute certainty that it is an onychomycosis and to specify the species of the microorganism involved, the so-called “culture examination” must instead be carried out.

In practice, the nail fragments that have not been used for microscopic analysis, are distributed on a gelatinous plate (culture medium), containing the nutrients necessary for the multiplication of microorganisms whose presence is suspected.

The plates are then kept at a temperature of 28-30 ° C if it is assumed to be a dermatophyte fungus or 37 ° C if it is preferred for Candida, for a period of 7-10 days in the first case and at least three days in the second.

After this time, circular and raised molds can usually be observed on the gelatinous surface: depending on their appearance (shape, color, distribution), the expert microbiologist will be able to understand what type of onychomycosis it is and the doctor choose the most suitable drug to counteract it.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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